Aortic dissection

Question 1

What is aortic dissection

Answer 1

Inner layer (intima) of aorta tears. Causes blood to surge through the tear causing the inner and middle layers (media) to separate. Causes a new false lumen and can lead to rupture

Question 2

Where does aortic dissection most likely occur

Answer 2

First 10cm of aorta

Question 3

What can weakening of aorta cause

Answer 3

Aneurysm or dissection

Question 4

What is the DeBakey classification of aortic dissection

Answer 4

I- Intimal tear is ascending aorta and descending aorta is also involved

II- Only ascending aorta involved

III- Only descending aorta involved

Question 5

What is Stanford classification of aortic dissection

Answer 5

A- Ascending aorta is involved (same as Debakey I and II)

B- Descending aorta is involved (same as Debakey III)

Question 6

Complications of aortic dissection

Answer 6

• Blood flow from the false lumen can flow up the aorta back into the heart and into pericardial sac leading to pericardial tamponade
• Blood flowing through false lumen could puncture the tunica media and externa leading to rupture and haemorrhage into mediastinum
• The false lumen can also cause compression of nearby vasculature such as subclavian or renal artery leading to hypoxia of upper limbs or kidneys respectively

Question 7

Risk factors for aortic dissection

Answer 7

Hypertension - main risk factor
Smoking 
Hyperlipidaemia
Thoracic AA
Aortic Valve abnormalities 
Family History 
Previous cardiac surgery 
Trauma  
Cocaine/Amphetamine Use 
Connective Tissue Disease - eg. Ehlers-Danlos or Marfan’s

Question 8

Aortic dissection signs and symptoms

Answer 8

Sharp chest pain- with radiation to back

Weak pulse in downstream arteries- Due to lack of blood flow to branched arteries

Difference in BP- difference between R and L arm

Hypotension

Shock- if there is rupture and significant blood loss

Question 9

Investigations for aortic dissection

Answer 9

CXR- Would show widened mediastinum due to widened aorta

Transoesophageal Echo - more sensitive

CT Angio- Give more detailed pic of blood vessels and tear in the vessels

Question 10

Management

Answer 10

Similar to dealing with aneurysm

A-E and stabilise pt

Vascular team involved

Question 11

MEdical managemet

Answer 11

Used if stable, chronic

Reduce BP using antihypertensives and B blockers

Question 12

Surgical management

Answer 12

Emergency surgical repair if 
-Increasing aortic diameter
-Compromise of major branches of aorta
Impending rupture
-Bleeding into thoracic cavity

-Surgical management involves resecting and replacing the area of the aorta with intimal tear